9909-135 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section,7000) of Division 3 of the Business and
Professionals Code, and my License is in full'force and effect.
License # Lic. Class ` Exp. Date
G56Y2£i C 3 WIA 2 i
Date Signature of Contractor
OWN ER-BUILDERI CLARATION '
I hereby affirm under penalty of perjury that I. am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION .
I hereby affirm under penalty of perjury one of the following declarations:
() I have and will maintain a certificate of consent to. self -insure for workers'
compensation,. as provided for by .Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
(„) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Cartier Policy No. '
a '.'AIT' i OND
(This'section need not be completed if the permit valuation is for $100.00 or,less).
O I certify that in the performance of the work for'which this permit is tissued,
I shall not employ any person in any manner so as to become, subject to the
workers' compensation laws of California, and agree that -P should become
subject to the workers' compensation provisions.ef°Secti 6 3700 of the.Labor
Code, I shall forthwith comply with thoseprov sli ons
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawf6l•and
shall subject an employer to criminal penalties and civil fines up to $100',000, in
addition to the cost of compensation, damages as provided for. in Secti6n.3706
of the Labor Code, interest.and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit 'subject to the conditions and .restrictions set forth. on.'his
application.
1. Each person upon whose behalf this application. is made & each person at
whose request and -for whose benefit work is performed under or pursuant.to
any permit issued as a result of this applicaton agrees to,.& shall, indemnify
& hold harmless'the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void.if
work is not commenced within 180 days. from date of issuance of such
permit, or cessation of work for 180 days will. subject permit to cancellation.
I certify that I have read this -application and state that the above information is
correct. I agree to comply with all City, and -State laws�relafingyto the building
construction, and hereby authorize representative,sv�dfthiVCity to enter'upon
the above-mentioned property for inspection purp'bsesft. ,
Signature (Owner/Agent).-- '' Date ,/�
BUILDING PERMIT PERMT#
99Yii,VM i ��
DATE J � � y; VALUATION S1,1." LOT TRACT
JOB SITE
ADDRESS '�+.'�%.`�, el,rbtil.�.,A'.�w.$.J��
APN _ +
OWNppER)
CONTRACTOR / DESIGNER /ENGINEER
f n
0.}ityhLk POOL[ & lS
%•.375 J�'�.�:tr..A13CKLi, LIS
74b 7,75 SO I DUVE #A
LA. QU N'YA Cit 92253
l() EJS�yYj.;Y I' CA
/PSR(�-�g\r?+v�Y. f922160 g
USE OF PERMIT
P430i, Ai'3.DAip', 811A
k Oi.:Y. AND S.PA
VCAM r+ivY`>iGit SPA 171,V30,001 S
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tvrei'L�,vai.Qrh rov
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-+
P,UenBBIWOVE.C. POOL 3t2t-00040400
SUB-110TAL CONS'H•i.1MION AND Pf,4r4 CHHiC .
$4417.95
TOTAL PEU1411T FC -01 IM E NOW
$407.85
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
t
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade `
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Hacks
Electric Bond
_
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
1 Encapsulation
Gas Piping
Gas Test
Appliances
Final
/
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
t
.,
I
September 8, 1999
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
(760) 776-5100 FAX (760) 776-5111
a
Mr. David Broude
Reference: 56-375 Jack Nicklaus Blvd., La Quinta
Architectural Change Request to Add Swimming Pool & Spa
Dear Mr, Broude:
The Planned Unit Development Architectural Committee at Its September 7,1999 meeting has
reviewed your revised plans to add a swimming pool and spa and wishes to advise that. your
plans as resubmitted have been approved.
Please contact Miguel Valenauela, supervisor for Valley Gardening Service at 760/399-1844 and
Carol Fuller, the Association Manager, prior to any irrigation modifications associated with this
change. Upon completion of changes, please contact Carol Fuller. Damage to the landscaping,
i.e., shrubs, trees, flowers and turf is the responsibility of the contractor. The landscaping must
be brought back to Its original condition when the project Is completed.
Approvals given by the Architectural Committee are good for only six months from the date
on the approval letter. After that time a new application must be submitted.
If you have any additional questions or concerns, please do not hesitate to contact Carol Fuller,
Association Manager, at 760,1776-5100, Ext. 20.
Sincerely,
PGA WEST H RESIDENTIAL ASSOCIATION
For the PUD Architectural Committee
Carol Fuller
Association Manager
cc: Board of Directors
Unit File